Physical activity after stroke – Why is it so low and how can we increase it?

Dóra Regőczi, Glasgow Caledonian University, @DoraRegoczi

About stroke

Stroke is a serious life-threatening medical condition which occurs when a part of the brain cannot get enough oxygen due to insufficient blood supply caused by a blockage or is damaged by a bleed. In the UK, there are over 100,000 strokes every year and it is a leading cause of disability (Stroke Association, 2018). The effects of a stroke depend on where it takes place in the brain and how big the damaged area is. Stroke survivors are often left to deal with serious, life-changing disabilities which has a huge impact on their daily life. Post-stroke impairments and limitations may affect physical, communicational, cognitive and psychological functioning (RCP, 2016). The stroke care pathway can include several steps from acute care, early rehabilitation, secondary prevention, early supported discharge, community rehabilitation, systematic follow-up, long-term support and in some cases palliative care (RCP, 2016).

Physical activity after stroke

Physical activity is viewed as an important element of this pathway with different roles and functions in each step: It can function as a prevention, rehabilitation and secondary prevention tool, and it has multiple benefits affecting cognitive, psychosocial, emotional and physical states (Saunders, 2020). Physical activity is relevant across the whole care pathway, however, observation studies highlighted that stroke survivors engage with limited amount of physical activity and high level of sedentary behaviour (Fini et al., 2017). Physical activity behaviour is a modifiable factor in stroke care and current research highlights the need to develop interventions aiming to increase physical activity and reduce sedentary behaviour after stroke (Moore et al., 2018). Understanding factors that may positively or negatively influence the uptake, progression and maintenance of physical activity after stroke could allow the development of appropriately targeted interventions for this population. These factors include individual, social and environmental elements (see Table 1). Most of these factors are also modifiable, therefore future interventions could target some or all of these factors.

How can healthcare professionals/exercise psychologists help to increase physical activity after stroke?

In healthcare, there are many opportunities to assess and advise patients on physical activity (Patrick et al., 2009) and several national and international guidelines encourage health care professionals to do so. In stroke care, The National Clinical Guidelines for Stroke (2016) recommend that people with stroke should be offered self-management support based on self-efficacy, aimed at the knowledge and skills needed to manage life after stroke. People with significant changes in self-esteem after stroke should be offered information, support and advice, and considered for psychological interventions to increase their physical activity (Jones & Raizi, 2010). Health care professionals are well placed to encourage positive behaviour patterns early and help translate mobility and functional gains made in therapy to an increase in physical activity in the longer term. Helping relationships can be predictive of stages of change when it comes to physical activity (Cardinal et al., 2004).

Research evidence and best practice guidelines recommend that an initiative to increase physical activity is most effective when combined with behaviour change strategies (Donkers et al., 2018). Behaviour change strategies can be defined as techniques designed to specifically address one or more psychological determinants of behaviour (Michie et al., 2018) and they make up the active components used in behaviour change interventions (Michie et al., 2013). A review by Stretton et al. (2017) found that those interventions targeting stroke survivors which were based on exercise alone had no significant effect, or they were less effective than those incorporating behaviour change techniques as well. Moore et al. (2018) compared nine studies and found that interventions were viewed more effective if they went beyond simple demonstration and guidance of physical activity after stroke and used psychosocial support methods (e.g. action planning, social support and problem solving). Controversially, another systematic review by Kringle et al. (2019) found inconsistent results and the authors were unable to identify intervention approaches that are superior for modifying full-day activity patterns in stroke rehabilitation. When studies were looking at long-term physical activity and maintenance of physical activity behaviour instead of looking at the uptake of physical activity stage of behaviour change, Morris, MacGillivray and Mcfarlane (2014) found that interventions involving tailored counselling are likely to be effective.

Similar to the factors influencing physical activity uptake and maintenance, physical activity promotion is also influenced by several factors (Table 2) coming from the providers, the environment and the receivers. Currently, there is limited research regarding physical activity promotion behaviour after stroke, therefore, looking at the more extensive evidence from the general healthcare setting may better inform our understanding. Crisford et al. (2018) highlighted that further investigation of the strengths, opportunities and effectiveness of physical activity promotion within the various health professions and settings is warranted in order to create successful, targeted interventions.

Practical recommendations for health care professionals/exercise psychologists

There are areas of uncertainty and further work is required to improve our knowledge and understanding on the best ways to increase physical activity after stroke. However, based on the available literature and the discussion above, the following recommendations could help you to support individuals to increase their physical activity level:

  • Stroke affects everyone differently, therefore an individually tailored approach is essential when it comes to assessing the physical activity needs of stroke survivors
  • There are several modifiable factors that influence physical activity behaviour after stroke. Being aware and targeting the most relevant ones for each individual can improve the uptake and maintenance of physical activity after stroke
  • There is a strong body of evidence supporting the implementation of behaviour change strategies into physical activity promotion. Familiarising yourself with these strategies can increase your own confidence and skills when it comes to supporting physical activity behaviour after stroke
  • Reflecting on your own resources and organisational environment can help you to identify barriers and increase your own physical activity promotion behaviour

Reference

Cardinal, B. J., Kosma, M. & McCubbin, J. A. (2004). Factors influencing the exercise behavior of adults with physical disabilities. Medicine & Science in Sports & Exercise, 36(5), 868-875.

Crisford, P., Winzenberg, T., Venn, A., Schultz, M., Aitken, D., & Cleland, V. (2018). Factors associated with physical activity promotion by allied and other non-medical health professionals: A systematic review. Patient education and counseling, 101(10), 1775-1785.

Donkers, S. J., Chan, K., Milosavljevic, S., Pakosh, M., & Musselman, K. E. (2018). Informing the training of health care professionals to implement behavior change strategies for physical activity promotion in neurorehabilitation: a systematic review. Translational behavioral medicine.

Drigny, J., Joussain, C., Gremeaux, V.,  Morello, R., Van Truc, P. H., Stapley, P., … & Ruet, A. (2019). Development and validation of a questionnaire to assess barriers to physical activity after stroke: the barriers to physical activity after stroke scale. Archives of physical medicine and rehabilitation, 100(9), 1672-1679.

Fini, N.A., Holland, A.E., Keating, J., Simek, J. & Bernhardt, J., (2017). How physically active are people following stroke? Systematic review and quantitative synthesis. Physical therapy, 97(7), 707-717.

Hébert, E. T., Caughy, M. O., & Shuval, K. (2012). Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review. Br J Sports Med, 46(9), 625-631.

Huijg, J. M., Gebhardt, W. A., Verheijden, M. W., van der Zouwe, N., de Vries, J. D., Middelkoop, B. J., & Crone, M. R. (2015). Factors influencing primary health care professionals’ physical activity promotion behaviors: a systematic review. International journal of behavioral medicine, 22(1), 32-50.

Jackson, S., Mercer, C., & Singer, B. J. (2018). An exploration of factors influencing physical activity levels amongst a cohort of people living in the community after stroke in the south of England. Disability and rehabilitation, 40(4), 414-424.

Jones, F., & Riazi, A. (2010). Systematic review of self-efficacy and stroke. Disabil Rehabil, 33, 797-810.

Kringle, E. A., Barone Gibbs, B., Campbell, G., McCue, M., Terhorst, L., Kersey, J., & Skidmore, E. R. (2019). Influence of Interventions on Daily Physical Activity and Sedentary Behavior after Stroke: A Systematic Review. PM&R.

Lawrence, M., Kerr, S., Watson, H., Paton, G., & Ellis, G. (2010). An exploration of lifestyle beliefs and lifestyle behaviour following stroke: findings from a focus group study of patients and family members. BMC Family Practice, 11(1), 97.

Michie, S., Carey, R. N., Johnston, M., Rothman, A. J., De Bruin, M., Kelly, M. P., & Connell, L. E. (2018). From theory-inspired to theory-based interventions: A protocol for developing and testing a methodology for linking behaviour change techniques to theoretical mechanisms of action. Annals of Behavioral Medicine, 52(6), 501-512.

Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., … & Wood, C. E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Annals of behavioral medicine, 46(1), 81-95.

Moore, S. A., Hrisos, N., Flynn, D., Errington, L., Price, C., & Avery, L. (2018). How should long-term free-living physical activity be targeted after stroke? A systematic review and narrative synthesis. International Journal of Behavioral Nutrition and Physical Activity, 15(1), 100

Morris, J. H., MacGillivray, S., & Mcfarlane, S. (2014). Interventions to promote long-term participation in physical activity after stroke: a systematic review of the literature. Archives of physical medicine and rehabilitation, 95(5), 956-967.

Morris, J., Oliver, T., Kroll, T., & MacGillivray, S. (2012). The importance of psychological and social factors in influencing the uptake and maintenance of physical activity after stroke: a structured review of the empirical literature. Stroke research and treatment, 2012.

Nicholson, S. L., Donaghy, M., Johnston, M., Sniehotta, F. F., Van Wijck, F., Johnston, D., … & Mead, G. (2014). A qualitative theory guided analysis of stroke survivors’ perceived barriers and facilitators to physical activity. Disability and rehabilitation, 36(22), 1857-1868.

Nicholson, S., Sniehotta, F. F., van Wijck, F., Greig, C. A., Johnston, M., McMurdo, M. E., … & Mead, G. E. (2013). A systematic review of perceived barriers and motivators to physical activity after stroke. International Journal of Stroke, 8(5), 357-364.

Patrick, K., Pratt, M., & Sallis, R. E. (2009). The healthcare sector’s role in the US national physical activity plan. Journal of Physical Activity and Health, 6(s2), S211-S219.

Royal College of Physicians (RCP), (2016). National Clinical Guideline for Stroke 5th Edition [online]. Royal College of Physicians. (viewed 01.03.2020)

Saunders, D. H., Sanderson, M., Hayes, S., Johnson, L., Kramer, S., Carter, D. D., … & Mead, G. E. (2020). Physical fitness training for stroke patients. Cochrane Database of systematic reviews, (3).

Stretton, C. M., Mudge, S., Kayes, N. M., & McPherson, K. M. (2017). Interventions to improve real-world walking after stroke: a systematic review and meta-analysis. Clinical rehabilitation, 31(3), 310-318.

Stroke Association (2018). State of the nation: Stroke statistics February. Available from: https://www.stroke.org.uk/sites/default/files/state_of_the_nation_2018.pdf (viewed 12.04.2020)

Vuori, I. M., Lavie, C. J., & Blair, S. N. (2013). Physical activity promotion in the health care system. In Mayo Clinic Proceedings, 88(12), 1446-1461

Be sure to keep an eye out for more insightful studies coming from Dóra’s PhD in the future.

An Exploration of Playfulness in Coaching

Stephanie Wheeler, @sgwheeeler

I was curious to research the area of playfulness in coaching as I had noticed both in myself and others that in times of perceived stress, my brain switched to pure logical goal-focused thinking.  Particularly before I started the path of development as a coach, a fog of ‘seriousness’ also descended on me in those periods.  On reflection, I wondered whether this automatic response narrowed down my thinking.  Did what I took for effectiveness and focus in fact rob me of the ability to broaden my thinking, potentially leading to different actions and outcomes?     

For the dissertation research for my MSc in Coaching & Behavioural Change (Henley Business School), I took the opportunity to explore this idea of playfulness in the context of coaching.  Research into adult playfulness is still at a relatively young stage and there is no universal consensus as to its conceptualisation, definition, measurement, distinctiveness or specificity.  Nevertheless, I find the definition proposed by Professor Proyer (2017) helpful as he divides the concept into a number of different categories, one of which is Intellectual playfulness.  In essence, this represents an enjoyment of playing with thoughts and ideas, embracing complexity and taking different perspective and is possibly associated with creative thinking as well as specific task/goal focus and problem solving.

It is this idea of Intellectual playfulness which was primarily explored in my research and subsequent article in the International Coaching Psychology Review (March 2020).  Based on interviews with 14 experienced coaches, working predominantly with corporate clients, the research is a qualitative study exploring and seeking to understand playfulness in coaching.  I identify strong themes in the research results of key factors required for playfulness and what it may bring to coaching.  Risks and potential barriers as well as future areas to investigate are also considered.  Based on a literature review of adult playfulness and the findings of my research, a new working definition is proposed. 

There is support in the research literature that there are benefits to adult playfulness, many of which appear relevant to coaching.  Yet with the experienced and reflective coaches who took part in this research study, many had not specifically reflected on playfulness in their coaching prior to participating.  My hope is that the article and underlying research will direct attention in the field of coaching to the concept of adult playfulness so that we can continue the exploration of its impact on coaching and its potential contribution to coaching effectiveness.

Stephanie Wheeler is a leadership and personal development coach working with individuals and teams.  Also a LEGO® SERIOUS PLAY® facilitator, speaker and writer, she is currently writing a book with Routledge with fellow coach Teresa Leyman in a further quest to explore the concept of playfulness and coaching. http://www.stephaniewheeler.co.uk

Meta-attention: shining the attentional spotlight

Alex Oliver, PhD Researcher, Glasgow Caledonian University, @aoliverpsych

Attention is a special type of spotlight that we can shine internally and externally to illuminate information we perceive to be important at that time, however, until recently we didn’t really have many insights into its operation. We use the term spotlight because attention is something that is always on; it’s always shining somewhere! Meta-attention, a component of the wider metacognitive framework, relates to our knowledge and awareness of the operation of our attentional system (Miller & Bigi, 1979). That is, what do we know about our own attentional spotlight, and how do we shine it?

Pioneering cognitive sport psychologist Aidan Moran pinpointed meta-attention as a pathway of understanding concentration in sport performers (Moran, 1996), however, little was done empirically to build on Moran’s suggestion for research to understand concentration. This meant that we did not have much understanding of what athletes know about their attention.

Our research aimed to fill this gap, by developing an understanding of what concentration looks like in golfers. Curiously other than the odd game of pitch and putt and crazy golf, I’ve never played a round of golf in my life! But, because of its unique nature, golf provides the perfect insight into concentration and attention control. A golfer can be out on the course for the best part of 5 hours yet they only need to concentrate – or focus – for a fraction for that. Therefore, we were interested in how a golfer shines their attentional spotlight – and what they think is the shiner.

We used a grounded theory approach and interviewed 8 golfers (7 competitive-elite, 1 successful-elite). The results showed that golfers perceived attention to be resource-based, with reflections (i.e., I have this resource or this resource is missing) on attentional resources, followed by an initiation of attentional control made up of target selection, pre-shot routine and following execution an initiation of a post-shot routine. The post shot-routine would be rounded off by something I’ve been informed is the golden rule in golf, think and talk about anything other than golf between shots!

If we link this back to the attentional spotlight, what this means is, first-of-all the spotlight shines internally – we look for a resource that might be useful for this moment in time. This might be an experience on playing a bunker shot. Because this is a metacognitive process, higher skilled athletes are more likely to be able to monitor for, locate and apply the most appropriate resource they need at that time. If an athlete fails to locate the resource required the negative appraisal can lead to internal distraction occurring.

The spotlight then shifts to target selection (e.g., that tree back right); on to a consistent pre-shot routine; the shot happens; the spotlight then shines towards a post-shot routine described as an evaluation box that would be exited by a player diverting their attention to anything other than their current game – something that may be facilitated by a playing partner or a caddie.

Practically what might this mean? First-of-all, if we consider metacognitive evaluation of attentional resource that takes place – the attentional spotlight identifies the resource and a reflection takes place – they either have a positive evaluation of this (e.g., my recent bunker shots are on point) or a negative evaluation (e.g., my bunker shots have been a disaster). So, we can begin to understand where internal distractions occur. At a theoretical level, mindfulness-based interventions may hold promise because this would reduce internal distractibility and we know these can increase flow which is associated with increased feelings of concentration (Kaufman et al., 2009).

Second, our understanding of meta-attention reiterated the selection of an external target, the use of a consistent pre-shot routine and post-shot routine. Practitioners should ensure that their athletes establish pre- and post-shot routines, especially in intermittent sports like golf where frequent shifts in the attentional spotlight take place. The use of a pre-shot routine can bring the attentional spotlight into task-relevant focus, and a post-shot routine can direct the attentional spotlight to evaluate the shot taken and then provide direction towards a task irrelevant thought.  

Our research presented a new theoretical understanding of meta-attention, in that we know a bit more about what it takes to control the attentional spotlight. This research has begun to shine a light on what mechanisms lie beneath the spotlight; showing us what the shiner is, but we still need to do more to deepen our understanding of the meta- mechanisms across cognitions, including further attention research.

This blog is adapted from an original article published in The Sport Psychologist (2020) and formed part of the authors’ PhD research.

We would be keen to connect with psychologists who are interested in metacognition in applied performance settings. For those interested, please contact Alex.

References:

Kaufman, K. A., Glass, C. R., & Arnkoff, D. B. (2009). Evaluation of Mindful Sport Performance Enhancement (MSPE): A new approach to promote flow in athletes. Journal of Clinical Sport Psychology3(4), 334-356.

Miller, P. H., & Bigi, L. (1979). The development of children’s understanding of attention. Merrill-Palmer Quarterly, 25, 235-250.

Moran, A.P. (1996). The psychology of concentration in sport performers. Hove, UK: Psychology Press.

Oliver, A., McCarthy, P. J., & Burns, L. (2020). A Grounded-Theory Study of Meta-Attention in Golfers. The Sport Psychologist34(1), 11-22.

Gaining insights into a coaches thought process through the use of Think Aloud: Perceptions of a High Performance Coach Developer, Jenny Coady.

Jenny Coady, High Performance Coach Developer at UK Coaching, @jennycoady10

Dr Amy Whitehead, Reader in Sport Psychology and Coaching, Liverpool John Moores University, @a_whitehead1

Jenny Coady is currently working as a high performance Coach Developer at UK Coaching, which involves supporting high performance coaches from around the UK in a variety of different ways. Jenny has a background in applied sport and exercise psychology, performance analysis and was an international athlete and uses this knowledge and expertise to develop the coaches she works with. 

Jenny was introduced to Think Aloud at a UK Coaching Coach Develop workshop that Amy delivered in 2018 and discusses how she has taken the tool on board within her practice as a coach developer.

How did you hear about Think Aloud?

I first had a chance to explore the Think Aloud concept at a UK Coaching Coach Developer workshop. It was a thought provoking presentation with a complimentary mix of theory and practical application. It is something that I immediately thought would be useful in my role as a coach developer and of course the performance coaches that I work with. We converse regularly about ‘normalising’ reflective practice so I was excited about the assistance this Think Aloud vehicle could provide

What were your initial thoughts?

It is an easy, adaptable, affordable and self-directed reflective tool. It’s multiple transferable components welcome coaches at all ages and stages of their coaching journey to engage. Knowing the coaches’ previous exposure to reflective tools and understanding their thought process, I was excited to share how this could support and possibly contribute to a deeper understanding. The simplistic and versatile nature of Think Aloud enabled me to introduce it quickly to coaches. The research supporting TA provided a solid foundation for coaches to digest and have clarity on the process. Reflective practice isn’t something that coaches find easy or in some cases a priority, the tool was both accessible and scalable for many coaches enabling them to implement it easily. This, for me, was a chance to change the way we approach reflection and to encourage in-depth reflection in a non-invasive way.

How did you first implement this in your role as a coach and a coach developer?

As a coach developer, I understand that coaching is multifaceted, taking many forms and happening in different environments. Think Aloud presents an opportunity for coaches to initiate the process in their own time, pace and space therefore it becomes bespoke to those coaches who take the time to embrace it. As a group of coaches, additionally we use a virtual platform to share experiences and reflections following the process. Once coaches begun sharing their ideas and experiences they were able to take the next step, exploring the tool further via workshops, lectures and research and implementing where necessary.

If any – how has Think Aloud developed or improved your practice?

Self-awareness and communication were the key areas that immediately presented themselves once the coaches had completed the process. Continued use of the tool highlighted further key areas including; coach-athlete relationships, language and diversion during coaching practice.  TA has refreshed the idea of reflection, a challenging process for many coaches. It has also given me a new insight into a coaches’ thought process and journey that I may not otherwise have seen. One of the interesting questions that Think Aloud has assisted some coaches in discovering ‘How I am being received by others?’. It has given many of the coaches’ confidence, they often feel that the quality, frequency and consistency of reflection has improved. TA has sparked my curiosity to explore reflection in action further, to contemplate and understand where and when it fits in the coaching process best.

If you would like to know more about the use of Think Aloud in coaching and coach development please get in touch with Dr Amy Whitehead via email A.E.Whitehead@ljmu.ac.uk or contact Jenny Coady via twitter @jennycoady10

‘‘Know-What vs Know-How’’: Contextual intelligence in effective sports consultancy

Elliot Sharpe, Loughborough University, @efsharpe

Every sport science consultant, whether from the disciplines of psychology, nutrition, physiology (etc.) will be immersed within the challenging and complex environment that is elite sport. Strictly speaking, sports consultants must show evidence of discipline-specific knowledge accumulated through a vast array of qualifications in order to accumulate the ‘know-what’ which can be drawn upon to enhance physical and mental strength, well-being, recovery and other performance related constructs. However, effective consultation involves more than knowledge of techniques and technical skills. It requires understanding the context in which you operate – knowing what works, with which persons, and in which situations. It is more than knowing what to do; it is knowing how to apply this to initiate meaningful change.

Contextual intelligence 

Being able to understand the values and attitudes of people at all levels of the sport requires high levels of awareness and empathy that the contemporary practitioner can utilise to improve the potential to become more effective. The contextually intelligent consultant recognises the language of the sport and system to make possible the prudent, intelligent, and illuminating application of technical knowledge in a meaningful way to generate change [1]. Although the term contextual intelligence [2] may be unfamiliar to some, it’s importance is reflected in various issues including (but not limited to): gaining entry [3], becoming accepted within a team, increasing intervention adherence, working with families [4] and NGBs, and helping others deal with organizational stress [5].

How to develop contextual intelligence 

The consultant with prior experience in the specific sport and is fluent in the culture’s language has a distinct advantage at initially understanding it’s technical information. Previous experience as an athlete is another activity that could help consultants understand the unique demands and pressures faced by athletes [2]. However, it is important to state that prior sporting experiences does not ensure practitioners will be effective, as there is potential to ignore the unique personal experiences of their clients [6]. Overall, I believe the most important way for consultants to develop contextual intelligence is to become immersed within a team that will help consultants build relationships and recognise how best to structure, deliver and promote their message in a way that can be clearly received and applied to key performance behaviours. This involves high levels of adaptability to adjust their consulting approach which can suit the specific needs of the client and further enhance the ability to connect with people in a more effective and genuine way [7].

Becoming immersed within the team

Contextual intelligence is typically associated with the ‘know-how’ that lies at the heart of building trusting, credible relationships in sport. It is the foundation by which consultants earn legitimacy and respect within a team. Becoming immersed within the team allows the consultant to build rapport and working alliances that is crucial to being able to integrate within coaching staff rather than operate as isolated consultants. In addition, observing the day-to-day practices within a team allows the consultant to recognise the most effective method of delivering an intervention that could be more likely to be accepted, gain subsequent ‘buy-in’ [8], and be understood in the language of the sport. This immersion also means that consultants may be exposed to disciplines outside of their technical expertise and offers the unique ability to shape others practice in an interdisciplinary fashion. 

In summary:

The concept of contextual intelligence is an important factor that could determine success as a sports consultant. Knowing what to do is often not enough to initiate meaningful change at an individual, team or organisational level. Knowing how to structure, implement and promote an intervention or strategy within a sport could be the important difference between being fit for practice or not [9]. Importantly, the time spent immersed within a team can help consultants develop contextual intelligence and ultimately build trust, respect and credibility. 

If you want to know more get in touch with Elliot (elliot.sharp@live.co.uk) or check out Elliot’s LinkedIn profile

How could we share our research findings with athletic populations?

Alister McCormick, Plymouth Marjon University, @ACM_SportPsych

Think about the intended beneficiaries of your research. How many of this population benefit from your research? How do your research findings get to them? Is there a risk that your research is being wasted, through not getting to them? How would this population prefer to get guidance and information that is based on your research findings?

The sport and exercise psychology community conduct a lot of research. As an applied profession, this research has the potential to benefit a range of athletic populations, including athletes, parents, coaches, practitioners such as sport therapists and rehabilitators, and recreational exercisers. Within these populations, research has the potential to impact outcomes relating to performance, health, injury, wellbeing, and quality of experience. Sport and exercise psychology researchers who want people to benefit from their research need to consider ways of sharing their findings so that people find and then engage with them. The sport and exercise psychology community are generally effective at sharing their research findings within the academic community, particularly through journal articles and academic conferences. So that our findings reach athletic, non-academic populations, it is important to also share findings using ways like websites and magazine articles, and to use different communication styles – Sommer (2006) referred to this as “dual dissemination”.

My own research to date has focused on endurance sports and demonstrated that psychological interventions can benefit the performances of people who participate or compete in endurance sports (for reviews, see McCormick, Meijen, & Marcora, 2015; McCormick, Meijen, Anstiss, & Jones, 2019). Thousands of people recreationally participate in endurance sports competitively and non-competitively, and most of these will not have access to a psychology practitioner who has read my research. I therefore wondered, how should I share my research-informed advice and guidance, in order to maximise its reach and impact?

To answer this question, I conducted a piece of research with Paul Anstiss and David Lavallee (McCormick, Anstiss, & Lavallee, 2018), which aimed to answer the following research questions: How do endurance-sport participants and athletes acquire guidance on psychological aspects of training for, preparing for, and performing in endurance events? And, what are their preferences for receiving psychological guidance? People in the UK (N = 574) who participated competitively or non-competitively in running (5km and greater), road cycling (time trials, road races, or sportives), or triathlon events completed an online survey. The main survey questions addressed how they have intentionally looked for psychological guidance in the last year, how they have got guidance without looking for it, and their preferences for receiving guidance. We found that the most common ways of intentionally finding guidance were looking on websites (48.1% of participants), asking other athletes (46.7%), and asking coaches (32.5%). People most commonly tried to find guidance on coping, motivation, and managing nerves. In relation to finding guidance without looking for it, we found that posts on social media (51.3%), spoken word (48.0%), and magazines (45.9%) were common ways of getting guidance. Other athletes (68.1%) and coaches (40.4%) were most often a source of guidance. Websites (49.5%) and online videos (41.8%) were the most preferred ways of receiving guidance, although others were psychologists working with coaches (35.5%) and event organisers (34.8%), and through reading about findings in magazines (34.7%).

Based on our findings, I encourage researchers to share evidence-based guidance using websites, online videos, social media, magazines, and by working with coaches and event organisers. Research conducted to date offers tips on how to communicate guidance with athletic populations: the language used should be accessible and user-friendly; content should be kept concise and simple; guidance should be practical and made concrete through specific examples, activities, exercises, tools, and materials (rather than just informational content); and downloadable resources such as workbooks and activities are likely to be helpful. These suggestions and other considerations such as required skillsets and media ethics are explored within the journal article (McCormick, Anstiss, & Lavallee, 2018).

RESIST, a DSEP-funded research working group (which stands for Research-evaluated Endurance Strategies Intending to Support Training) has engaged with these ways of sharing evidence-based guidance on how to overcome the urge to stop, slow down, walk, or quit during endurance events. In particular, we have launched a website that includes evidence-based written guidance and online videos relating to how to overcome the urge to stop, including using psychological strategies such as if-then planning, self-talk, pacing decision making, goal setting, cueing techniques, controlling attentional focus, and re-appraisal (www.resist-stopping.com).

Looking forward to the future, it would be great to see sport and exercise psychology researchers sharing guidance and suggestions based on their research, using ways such as websites, online videos, social media, magazines, and by working with coaches and event organisers. It would also be great to see experimental research testing the effects of interventions that are delivered in these preferable and realistic formats.

For further detail on the study findings check out the full open access paper: McCormick, A., Anstiss, P. A., & Lavallee, D. (2018). Endurance athletes’ current and preferred ways of getting psychological guidance. International Journal of Sport and Exercise Psychology, 1-14. https://marjon.collections.crest.ac.uk/17244/

References

McCormick, A., Anstiss, P. A., & Lavallee, D. (2018). Endurance athletes’ current and preferred ways of getting psychological guidance. International Journal of Sport and Exercise Psychology. https://doi.org/10.1080/1612197X.2018.1486874

McCormick, A., Meijen, C., Anstiss, P., & Jones, H.S. (2019). Self-regulation in endurance sports: theory, research, and practice. International Review of Sport and Exercise Psychology, 9, 235-264.https://doi.org/10.1080/1750984X.2018.1469161

McCormick, A., Meijen, C., & Marcora, S. (2015). Psychological determinants of whole-body endurance performance. Sports Medicine, 45, 997-1015. https://doi.org/10.1007/s40279-015-0319-6

Sommer, R. (2006). Dual dissemination: Writing for colleagues and the public. American Psychologist, 61, 955–958. https://doi.org/10.1037/0003-066X.61.9.955

The Importance of Choice of Rehabilitation Techniques Following Injury in Footballers

Coral-Jade Oakley, Southampton Solent University, @coraljadeoakley

The original basis for this research project was my enthusiasm to study female footballers – being one myself. In addition, I had previously suffered an ACL tear which came with psychological consequences so I was interested to find out whether other athletes experienced the same effects and whether different rehabilitation programmes may have benefitted them.

Injury is a dominant part of football and the rehabilitation process is becoming more advanced; hence the growing amount of research surrounding male footballers. However, there is little research focusing on females (Junge and Dvorak 2007) and therefore comparing the needs of both genders during rehabilitation. It has been found in previous research that emotional response and cognitive appraisals differ between genders, however, there has been little thought into whether males and females require the same treatment post-injury – researching both genders means that we can predict differences in psychological response (Granito 2002).  This explains the need for this research into the psychological effects of lower limb injury on male and female footballers and the implication this has on choice of rehabilitation techniques.

There are multiple models which can help explain the psychological response of injury: Grief-Response Model (Kubler-Ross 1969), Cognitive-Appraisal Model (Weise-Bjornstal 1998), Biopsychosocial Model (Brewer 2009) and the Integrated Model (Weise-Bjornstal 1998). This research uses these models to determine the cognitive appraisals, emotions and responses experienced by athletes and show how they may explain the differences between genders.

I used a case study, qualitative design to carry out this research project in which I interviewed 4 male and 4 female participants using a semi-structured interview – asking them about their injury experience, opinions on rehabilitation and psychological effects that came with their injury. This naturally adopted a latent, deductive approach which was then analysed through the six stages of thematic analysis. This approach easily outlined common themes in the interview data and I was able to group and order the themes and produce significant results.

Image result for female football injury

The main themes of psychological response to injury were fear of re-injury (an expected result as Tripp et al. (2007) found that both genders suffer from a decreased confidence from fear of re-injury), anxiety and anger/frustration. However, these emotions were different between males and females as they didn’t experience the same psychological response post-injury; hypothesised by previous studies on injury (Santi and Pietrantoni 2013). For example, females felt more anxiety regarding returning to football and attending rehabilitation sessions where-as males experienced more anger and frustration towards their injury. This is important because it suggests that males and females may need different types of rehabilitation depending on the emotions experienced post-injury. In order to determine whether males and females responded differently when experiencing the stress of injury, we need to understand how the feelings and emotions of both genders differ. Newer research supports this; suggesting that females respond differently due to the function and chemistry of the brain (Brizendine 2008).

Moving forward with my findings, the answers given by participants suggested that the emotions experienced by athletes did directly link to their appraisals and perceptions of necessary rehabilitation techniques. For example, the female athletes sought social support from family and friends where-as the male athletes didn’t deem this as necessary for their recovery. Interestingly, athletes that experienced more intense emotions during their rehabilitation process highlighted psychological interventions such as imagery and self-talk to be beneficial to their recovery – or would have been if it had been offered to them.

The findings in this research were very interesting yet expected when looking at recent research into this field of study; suggesting that both genders do in fact require and would benefit from different treatment and rehabilitation programmes and this would be entirely dependent upon the emotions they experienced post-injury. Therefore I feel that my research project and findings are beneficial for coaches, physiotherapists and psychologists in order to understand the cognitions, appraisals and perspectives of injured athletes and how both genders may require different treatment.

An important note to take from this research, however, is that past research and theories (e.g. Male Gender Role Identity Model – Brannon 1976) suggest that males are less engage in talking openly about their emotions of rehabilitation and this may explain some of the differences in results found.

If you wish to receive a copy of his full research project, please email: coral.oakley1@hotmail.com

LinkedIn: Coral-Jade Oakley

Website: cozxakley.wordpress.com

References:

BRIENDINE, L. 2008. The Female Brain. USA.

JUNGE, A.; DVORAK, J. 2007. Injuries in Female Football Players in Top Level International Tournaments. England; BMJ Publishing Group LTD. Pp.7

TRIPP, D.A. 2007. Fear of Re-Injury, Negative Affect, ad Catastrophising Predicting Return to Sport in Recreational Athletes with Anterior Cruciate Ligament Injuries at 1 Year Post-Surgery. Rehabilitation Psychology. 52 (1). 74-81.

Technology use with Club Level Gaelic Footballers – some Food for Thought

Photo by Brendan Moran/Sportsfile

Cathal Tweddle, Dromard GAA, @CathalT88

This blog post will give some insight into the lived experience of technology use within club level Gaelic Footballers and the potential implications of such for coaches or psychologists using technology with their athletes. The information and quotes are taken from a qualitative study which I carried out with 6 club Gaelic Footballers as part of my final year undergraduate project in Dublin Business School under the supervision of Dr. Lucie Corcoran.

For those who are unaware of the sport, Gaelic Football is one of four indigenous sports governed by the Gaelic Athletic Association (GAA) in Ireland. It is one of the most popular spectator and participatory sports in the country. A GAA club exists in almost every community on the island of Ireland, with over 2200 GAA clubs in existence throughout the 32 counties, providing native sports for approximately 330,000 participants  All GAA players are amateur and do not get paid for their participation at any level.

Every Gaelic Footballer plays for his/ her local club and they usually play with this club right until retirement. This makes GAA unique from many other sports as transfers between clubs are uncommon and this fosters a deep sense of community and pride in your local area. Each year every club competes for the county championship within their own county. Clubs are graded according to ability across three tiers with junior grade catering for weaker clubs, intermediate grade catering for tier two clubs and senior grade catering for elite clubs within a county. Elite players from club championships are selected to represent their county and compete in the All-Ireland championships which are broadcasted on Sky Sports during the summer, however, exclusively club players represent the vast majority of the association’s playing population.

©INPHO/Lorraine O’Sullivan

To date, research looking at the effect that technology is having on the lived experience of its users in any sports setting has been lacking (Hurley, 2018). The aim of the research was to begin to fill this void by investigating how technology has effected the lived experience of club Gaelic Footballers. I encountered some very interesting themes and results in this regard.

In recent years there has been an ever increasing presence of sports science, strength and conditioning and data analysis present in the preparation of intercounty teams (Kelly, Banks, McGuinness & Watson, 2018). Intercounty teams regularly play in front of 80,000 spectators during championship season and as such heightened levels of preparation come as no surprise. Interestingly however, as technologies have become more readily available and cheaper to access as a whole, the increasingly professional level of preparation observed with elite teams has trickled down to club teams. The use of GPS monitoring, Video analysis and communication tools such as WhatsApp and teamer have now become common place at club level, far away from the bright lights of Croke Park (Hurley, 2018; Martin, Swanton, McGrath, & Bradley, 2017).

Firstly, there was a general positivity towards being able to use technology within the team environment and it was felt that team communication apps such as WhatsApp help in overall team cohesion. It is now easier than ever to organise matches and training sessions. A unique aspect of the GAA is that although many players live in the major cities such as Dublin, Galway and Cork, they still travel home at weekends and sometimes during the week for training sessions and matches with their local club team. Where these drives are untenable during the week, players train on their own or with local teams in the city and send on pictures of their training to the WhatsApp group.

‘if I’m training in Dublin like I can show people that I’m training in Dublin… I don’t feel as if people think I’m not there or not.’

Video analysis was observed to vary greatly in quality. There was a general acceptance that it was worthwhile but often times, because it was implemented by the coach not qualified in the area of video analysis, it was seen to do more harm than good. Some players even admitted to being ‘anxious’ going into the sessions and felt that their confidence was being damaged. One player even suggested that players can became so aware of being constantly highlighted that they can became more conservative in games.

‘if you use too much video work players can become conscious of .. the camera is there and are probably less inclined to take a risk or something or you know deviate at all from the team plan…’

Managers as well as players seemed to display a general lack of understanding of GPS readings. Rather than use it as a tool to monitor training load and help with injury prevention, it was being ‘used as a stick’ to beat players with and pulling them up when their numbers weren’t deemed good enough.

Like anything in life, Individual differences were observed. While some players were motivated by certain tools, others were not, particularly in regards GPS results.

‘I like to see Ok he’s actually running it in that time, I’ll actually maybe try and beat that’

‘I’m not going to do any more running because someone is going to be looking at the GPS numbers’

The most interesting point to come from the study perhaps was that players felt it was taking away from their enjoyment of participating.

‘it can actually maybe detract from the enjoyment of actually just playing sport.’

‘It’s supposed to be an escape from the mundane aspects of life.’

The study has certainly not solved anything nor does it profess to, however, if you are a coach or psychologist using technology with your players or team, it does provide some interesting food for thought. Is your use of technology adding to or taking away from your athletes experience? Do you and your athletes fully understand why you are using a piece of technology? And finally have you considered how your feedback from these tools could effect the athlete going forward both on and off the pitch?

References

Hurley, O. A. (2018). Sport Cyberpsychology. Oxford: Routledge.

Kelly, Banks, McGuinness & Watson. (2018). Playing Senior Inter-County Gaelic Games: Experiences. realities and Consequences. ESRI Research Series. Issue 76. Doi: https://doi.org/10.26504/rs76

Martin, D., Swanton, A., McGrath, D., & Bradley, J. (2017). The use, integration and value of performance analysis to GAA coaches. Journal of Human Sport and Exercise, 12(2.), 492–501. doi:10.14198/jhse.2017.12.proc2.02

Personal Information.

Cathal Twaddle is a GAA coach based in Co. Longford in Ireland. He has competed in Olympic Weightlifting, Rugby, Gaelic Football and Soccer at various levels. Cathal has been involved in coaching teams from the age of 16 and has worked as Assistant Strength Coach with Longford GAA’s Senior Intercounty Footballers as well as coached numerous club teams including Grattan Óg GAA  Club underage teams, St. Mary’s GAA Club Granard Senior Footballers, Co. Longford, Carrigallen GAA Club Senior Footballers, Co. Leitrim and is currently involved with the Dromard GAA Club Senior Football team in Longford. Having previously qualified as a primary school teacher, Cathal has just completed an Undergraduate Degree in Psychology and hopes to continue studying Sports Psychology and in particular Sports Cyberpsychology in the coming years.

If you want to hear more about Cathal’s work follow him on twitter: @CathalT88

Performance Enhancing Drug use in the Military

Dr Ian Whyte, University of Sunderland

The use of performance and image enhancing drugs (PIEDS) is a highly publicised problem within sports, with athletes testing positive on a regular basis, for example nine UK athletes faced a ban for PIEDS use in 2018 alone! However, less is known about the use of PIEDS in other highly physical and demanding professions such as the armed forces. National newspapers have picked up on the issue of PIEDS use in forces personnel (e.g. Shute, 2013, “Is body-building bad for soldiers’ health?” Daily Telegraph) and research studies have been conducted with current members of the UK armed forces (e.g. Casey et al, 2014). However, there have been little to no follow-up or separate studies to consider the usage of PIEDS among ex-Service personnel or those in transition. Given the potential health and social consequences of PIEDS use, it is important that this gap in knowledge is filled.

A research team based at the University of Sunderland lead by Dr Ian Whyte are aiming to find out just that. The project is funded by Forces in Mind Trust (FiMT) and aims to understand why ex-service personnel use performance and image enhancers. The study also aims to increase the understanding of when ex-service personnel began using PIEDS, as well as the overall knowledge base of military veterans surrounding PIED use and its consequences. This research aims to further the current literature in relation to the motivations, perceptions and experiences of PIEDS users who have served in the military.

PIEDS use has become a health concern within the wider community, and the armed forces are a community that could potentially be more vulnerable to the lures of PIEDS due to the physical and emotionally demanding nature of military service. This research will allow the armed forces and veteran communities to better understand if PIEDS use is a problem within ex-service personnel and how best to support this group moving forwards. The research team are currently conducting a systematic review of the current literature relating to PIEDS use in military service personnel and veterans. This will then be followed by a mixed methods investigation into PIED use in a North East military veteran sample.

Watch this space for more about this study

Online support and learning opportunities: Valuable features in the athlete/performer world

Dr Olivia Hurley, Dun Laoghaire Institute Of Art Design + Technology, @DrOliviaHurley, Author of Sport Cyberpsychology

While the online world has come in for, perhaps, some justifiable criticism in recent times, it would be an injustice to vilify the benefits the online world offers to many individuals too, especially in the domain of sport and performance. Athletes and performers across many disciplines, and levels of performance, use the online world frequently because it is a valuable resource for them, for so many reasons, including: (i) to be inspired, (ii) to discover new information, (iii) to remaining in contact with others and (vi) for entertainment purposes (Hurley, 2018).

The Internet enables athletes (coaches and spectators too) from all over the world to view what others in their fields of performance or interest are achieving. It can inspire them to raise their own standards in order to match, and perhaps even supersede, such accomplishments. One of the basic principles of human learning is that of modelling the behaviour of others (Bandura, 1977). That is, individuals often learn by mimicking or copying what they see other individuals doing. In sport and performance settings, this is no different and online, visually/video-based, platforms such as You Tube, as well as social media outlets such as Facebook, Twitter and Instagram, allow activities to be recorded, uploaded and watched repeatedly, until that behaviour or skill being performed has been mastered (Boschker, & Bakker, 2002; Boyer, Miltenberger, Batsche & Fogel, 2009). Before the online world, such behaviours often needed to be witnessed in person or were recorded with devices much less transportable that today’s ipads or smartphones, in order for them to be learned, replayed and mastered by others. The online world has remove such inconveniences.

The online world also provides individuals from various sport and performance communities, including coaches and officials, with invaluable opportunities to advance their knowledge-base or to ‘up-skill’ (Hurley, 2018; Leinster Rugby, 2017). Online learning platforms such as Blackboard and Moodle, for example, allow education and coaching programmes to be offered to all kinds of students, with all kinds of backgrounds and specific needs. One of the main, and obvious, advantages of such online learning is that it removes the barriers of location (Kreb & Lockee, 2009). Therefore, a person in nearly any part of the world with Internet access today, can potentially study any discipline not offered in a traditional, on-campus, setting within their own geographical location. Not only does this present individuals with new and exciting learning opportunities for up-skilling their current mastery level, it also generates significant revenue for the institutions offering such online learning programmes, in a very cost-effective way (because lower overhead costs are incurred in the running of such programmes, by using online delivery methods).

The online world also offers many opportunities for like-minded individuals to communicate with each other and support each other in ways not possible before the creation of the Internet. For example, today, injured or retiring athletes and performers across the world often receive hundreds, if not thousands, of messages of support via their social media networks when they are often in greatest need of such important support (Bejar et al., 2017). Periods of rehabilitation and career transition or retirement can be physically and mentally challenging for many people. Supported athletes and performers have spoken publicly in the media about the importance of such social support in helping them to manage those difficult times (The 42, 2017). They have frequently commented how the support they received helped them to remember they are members of special communities. Such awareness may have been forgotten by such individuals in the years before the Internet was created.

One also should not forget that athletes and performers are individuals and people first, before considering what they do in life as a career. The online world enables members of the wider public to see that such people have other interests and hobbies, fun, family, and friendships outside of their careers and public personas. Before the online world, such in-depth information and knowledge was not available to the general public (Hurley, 2018).

So, as stated at the start of this article, while the online world has come in for some justifiable criticism in recent times, it would be an injustice to vilify the benefits the online world offers to many individuals, especially in the domain of sport and performance.

Reference List

Bandura, A. (1977).Social learning theory. Englewood Cliffs, NJ: Prentice Hall.

Bejar, M.P., Fisher, L.A., Nam, B.H., Larsen, L.K., Fynes, J.M., & Zakrajsek, R.A. (2017). High-

level Korean athletes’ experiences of injury and rehabilitation. The Sport Psychologist, 31, 16-29. 

Boschker, M. C. J., & Bakker, F. C. (2002). Inexperienced sport climbers might perceive and

utilize new opportunities for action by merely observing a model. Perceptual and Motor Skills, 95, 3–9.

Boyer, E., Miltenberger, R.G., Batsche, C., & Fogel, V. (2009). Video modeling by experts with

video feedback to enhance gymnastics skills. Journal of Applied Behaviour Analysis, 42, 855-860.

Hurley, O. A. (2018). Sport Cyberpsychology. London: Routledge. 

Kreb, S.G., & Lockee, B.B. (2009). Supporting student-athletes through distance learning: a

game plan for success. Paper presented at the 25th Annual Conference on Distance Teaching and Learning.

Leinster (2017). Leinster Rugby continues collaboration with St. Mary’s University,

Twickenham. Retrieved from: http://www.leinsterrugby.ie/leinster-rugby-continues-collaboration-with-st-marys-university-twickenham/.

The 42. (2017). Jockey Mark Enright on how he overcame depression. Retrieved from: https://www.youtube.com/watch?v=jmsD79Mu9zw